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Table 3 Grading system for extranodal extension for metastatic lymph node established by Lewis et al [49].

From: De-intensification of adjuvant therapy in human papillomavirus-associated oropharyngeal cancer

Extra Nodal Extension Grading System
Grade Histologic Finding ENE positivity
0 Tumor is surrounded by lymphoid tissue
1 Tumor reaches the capsule (with no intervening lymphoid tissue) with thickening of overlying capsule
2 Tumor in perinodal tissue, extending ≤ 1 mm beyond capsule +
3 Tumor in perinodal tissue and extending > 1 mm beyond capsule +
4 Tumor mass without residual nodal tissue or architecture. No residual lymphoid architecture or germinal center. +
  1. Higher grader corresponds with more severe ENE. Grades 0–1 are usually defined as negative ENE while grades 2–4 are defined as positive ENE. Grade 4 also designated as Soft Tissue Metastasis